The medical community is increasingly recognizing the vital role of plant-based diets in preventative health. Major healthcare providers like Kaiser Permanente are acknowledging the benefits of plant-based eating for managing and potentially reversing chronic diseases. This article aims to provide a detailed overview of Kaiser Permanente's plant-based diet guidelines, exploring the scientific evidence supporting these recommendations and offering practical guidance for individuals and healthcare professionals.
The Growing Recognition of Plant-Based Diets
Health care professionals across the country and around the world have begun to recognize the crucial role that a balanced plant-based diet plays in maintaining health and reversing disease. While many research scientists and practicing physicians have long understood this, major industry players such as Kaiser Permanente are now coming on board. The Permanente Journal is assembled by a group of Kaiser clinicians “to promote the delivery of superior health care through the principles and benefits of Permanente Medicine.” With 8.9 million members enrolled in its health plan and 14,600 physicians on its payroll, Kaiser Permanente is poised to lead the nation in establishing better protocols for preventive care. The growing consensus is that plant-based diets are no longer a fringe preference but a cornerstone of good health.
The Core Principles of a Plant-Based Diet
Healthy eating may be best achieved with a plant-based diet, which encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods. A healthy, plant-based diet aims to maximize consumption of nutrient-dense plant foods while minimizing processed foods, oils, and animal foods (including dairy products and eggs). It encourages lots of vegetables (cooked or raw), fruits, beans, peas, lentils, soybeans, seeds, and nuts (in smaller amounts) and is generally low fat. It is vital to know the specific definitions of related diets and to ascertain the details of a patient’s diet rather than making assumptions about how healthy it is.
Variations within Plant-Based Diets
Leading proponents in the field have varying opinions as to what comprises the optimal plant-based diet. Despite these smaller differences, there is evidence that a broadly defined plant-based diet has significant health benefits. It should be noted that the term plant-based is sometimes used interchangeably with vegetarian or vegan. Vegetarian or vegan diets adopted for ethical or religious reasons may or may not be healthy.
Here's a brief summary of typical diets that restrict animal products:
Read also: Does Kaiser cover Ozempic for weight loss?
- Vegan (or total vegetarian): Excludes all animal products, especially meat, seafood, poultry, eggs, and dairy products.
- Mediterranean: Similar to whole-foods, plant-based diet but allows small amounts of chicken, dairy products, eggs, and red meat once or twice per month. Fish and olive oil are encouraged.
- Whole-foods, plant-based, low-fat: Encourages plant foods in their whole form, especially vegetables, fruits, legumes, and seeds and nuts (in smaller amounts). For maximal health benefits this diet limits animal products.
The Scientific Evidence: Health Benefits of Plant-Based Diets
Research consistently demonstrates the numerous health advantages of plant-based diets. These benefits span various aspects of health, including weight management, diabetes prevention and management, and cardiovascular health.
Weight Management
In 2006, after reviewing data from 87 published studies, authors Berkow and Barnard13 reported in Nutrition Reviews that a vegan or vegetarian diet is highly effective for weight loss. They also found that vegetarian populations have lower rates of heart disease, high blood pressure, diabetes, and obesity. In addition, their review suggests that weight loss in vegetarians is not dependent on exercise and occurs at a rate of approximately 1 pound per week. Farmer et al14 suggest that vegetarian diets may be better for weight management and may be more nutritious than diets that include meat. In their study, they showed that vegetarians were slimmer than their meat-eating counterparts. Vegetarians were also found to consume more magnesium, potassium, iron, thiamin, riboflavin, folate, and vitamins and less total fat. In 2009, Wang and Beysoun15 analyzed the nationally representative data collected in the 1999-2004 National Health and Nutrition Examination Survey. The aim of their study was to analyze the associations between meat consumption and obesity. The Oxford component of the European Prospective Investigation into Cancer and Nutrition assessed changes in weight and BMI over a five-year period in meat-eating, fish-eating, vegetarian, and vegan men and women in the United Kingdom. During the five years of the study, mean annual weight gain was lowest among individuals who had changed to a diet containing fewer animal foods. According to Sabaté and Wien,18 “Epidemiologic studies indicate that vegetarian diets are associated with a lower BMI and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI. Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children. The short answer, yes, depending on how much you embrace a whole foods plant based diet. “You’re naturally reducing foods in your diet that are high in fat, calories, refined sugars, sodium and processed foods, which will help you lose weight,” Lee says. Also, a plant-based diet is naturally high in fiber, which is great for keeping you full throughout the day, aiding in digestion and preventing cancer. Eating a plant based diet gets you the “biggest bang for your buck,” explains Lee. But something to keep in mind? Weight loss is different for every person. “This isn’t a quick fix diet,” Lee says. “This is a lifestyle way of eating.”
Diabetes Prevention and Management
Plant-based diets may offer an advantage over those that are not plant based with respect to prevention and management of diabetes. The Adventist Health Studies found that vegetarians have approximately half the risk of developing diabetes as nonvegetarians.19 In 2008, Vang et al20 reported that nonvegetarians were 74% more likely to develop diabetes over a 17-year period than vegetarians. Barnard et al21 reported in 2006 the results of a randomized clinical trial comparing a low-fat vegan diet with a diet based on the American Diabetes Association guidelines. People on the low-fat vegan diet reduced their HbA1C levels by 1.23 points, compared with 0.38 points for the people on the American Diabetes Association diet. Eating a plant-based diet is also a great way to prevent, manage, or reverse diabetes, Lee says.
Cardiovascular Health
In the Lifestyle Heart Trial, Ornish10 found that 82% of patients with diagnosed heart disease who followed his program had some level of regression of atherosclerosis. Comprehensive lifestyle changes appear to be the catalyst that brought about this regression of even severe coronary atherosclerosis after only 1 year. Interestingly, 53% of the control group had progression of atherosclerosis. After 5 years, stenosis in the experimental group decreased from 37.8% to 34.7% (a 7.9% relative improvement). The control group experienced a progression of stenosis from 46.1% to 57.9% (a 27.7% relative worsening). Low-density lipoprotein had decreased 40% at 1 year and was maintained at 20% less than baseline after 5 years. In the Lyon Diet Heart Study, a prospective, randomized, secondary prevention trial, de Lorgeril found that the intervention group (at 27 months) experienced a 73% decrease in coronary events and a 70% decrease in all-cause mortality. The intervention group’s Mediterranean-style diet included more plant foods, vegetables, fruits, and fish than meat. Butter and cream were replaced with canola oil margarine. In 1998, a collaborative analysis using original data from 5 prospective studies was reviewed and reported in the journal Public Health Nutrition. It compared ischemic heart disease-specific death rate ratios of vegetarians and nonvegetarians. Although vegetarian diets are associated with lower risk of several chronic diseases, different types of vegetarians may not experience the same effects on health. In 2010, the Dietary Guidelines Advisory Committee performed a literature review to identify articles examining the effect of dietary patterns on blood pressure in adults. The Dietary Guidelines Advisory Committee also performed a 2010 literature review to determine the effect of plant-based diets on stroke, cardiovascular disease, and total mortality in adults. In 2012, Huang et al31 performed a meta-analysis to investigate cardiovascular disease mortality among vegetarians and nonvegetarians. They only included studies that reported relative risks and corresponding 95% confidence intervals. Seven studies with a combined total of 124,706 participants were analyzed.
A Case Study: The Power of Plant-Based Nutrition
A 63-year-old man with a history of hypertension presented to his primary care physician with complaints of fatigue, nausea, and muscle cramps. The result of a random blood glucose test was 524 mg/dL, and HbA1C was 11.1%. Type 2 diabetes was diagnosed. His total cholesterol was 283 mg/dL, blood pressure was 132/66 mmHg, and body mass index (BMI) was 25 kg/m2. He was taking lisinopril, 40 mg daily; hydrochlorothiazide, 50 mg daily; amlodipine, 5 mg daily; and atorvastatin, 20 mg daily. He was prescribed metformin, 1000 mg twice daily; glipizide, 5 mg daily; and 10 units of neutral protamine Hagedorn insulin at bedtime. His physician also prescribed a low-sodium, plant-based diet that excluded all animal products and refined sugars and limited bread, rice, potatoes, and tortillas to a single daily serving. He was advised to consume unlimited non-starchy vegetables, legumes, and beans, in addition to up to 2 ounces of nuts and seeds daily. The patient was seen monthly in his primary care clinic. Over a 16-week period, significant improvement in biometric outcome measures was observed. He was completely weaned off of amlodipine, hydrochlorothiazide, glipizide, and neutral protamine Hagedorn insulin. Follow-up blood pressure remained below 125/60 mmHg, HbA1C improved to 6.3%, and total cholesterol improved to 138 mg/dL. The presented case is a dramatic example of the effect a plant-based diet can have on biometric outcomes like blood pressure, diabetes, and lipid profile. The reduction in HbA1C from 11.1% to 6.3% in 3 months is much better than would be expected with monotherapy with metformin6 or daily exercise.7 The improvement in blood pressure observed over a 4-month period with few medications is also rarely encountered in clinical practice and is likely related to a low-sodium diet and the avoidance of red meat.
Read also: Coverage for Skin Removal Surgery
Nutritional Considerations for Plant-Based Diets
Generally, patients on a plant-based diet are not at risk for protein deficiency. Proteins are made up of amino acids, some of which, called essential amino acids, cannot be synthesized by the body and must be obtained from food. Essential amino acids are found in meat, dairy products, and eggs, as well as many plant-based foods, such as quinoa.32 Essential amino acids can also be obtained by eating certain combinations of plant-based foods. Examples include brown rice with beans, and hummus with whole wheat pita. It is important to be mindful of certain nutrients that may require special attention in plant-based diets.
Protein
Calculations for how much protein you need is based on an individual’s body weight, Lee explains. But, a good baseline is about 46+ grams per day women and 56+ grams per day for men. “When you’re getting your protein from plant-based sources, you’re getting adequate protein for normal cell development as well as preventing the increased risk of developing chronic illnesses, including many cancers, Type 2 diabetes and inflammatory diseases,” Lee says. You can get 12 grams of protein in ¼ cup of chia seeds and 5 grams of protein in ¼ cup of walnuts. A cup of cooked lentils packs 18 grams of protein and the same amount of black beans has 15 grams of protein. When it comes to grains, 1 cup of cooked whole-wheat couscous has 6 grams of protein and the same amount of quinoa has anywhere from 5 to 8 grams of protein. As far as veggies go, corn on the cob, potatoes with their skin, oyster mushrooms, collard greens, peas, artichoke, broccoli and brussel sprouts your best protein bets.
Iron
Plant-based diets contain iron, but the iron in plants has a lower bioavailability than the iron in meat. Plant-based foods that are rich in iron include kidney beans, black beans, soybeans, spinach, raisins, cashews, oatmeal, cabbage, and tomato juice.38 Iron stores may be lower in individuals who follow a plant-based diet and consume little or no animal products.
Vitamin B12
Vitamin B12 is needed for blood formation and cell division. Vitamin B12 deficiency is a very serious problem and can lead to macrocytic anemia and irreversible nerve damage. Vitamin B12 is produced by bacteria, not plants or animals.
Calcium
Calcium intake can be adequate in a well-balanced, carefully planned, plant-based diet. People who do not eat plants that contain high amounts of calcium may be at risk for impaired bone mineralization and fractures. However, studies have shown that fracture risk was similar for vegetarians and nonvegetarians. The key to bone health is adequate calcium intake, which appears to be irrespective of dietary preferences.42 Some significant sources of calcium include tofu, mustard and turnip greens, bok choy, and kale. A good indicator if a veggie is loaded with calcium is it’s green (the darker, the better) and leafy, Lee dishes. Collards, broccoli, brussel sprouts and kale are all great green sources of calcium. Other plant-based sources high in calcium include beans, figs, raisins, navel oranges, butternut squash and sweet potatoes. If you’re looking for a calcium fortified plant-based milk, some options include unsweetened almond, hemp, coconut, soy, rice and hemp milks, Lee says. “If you’re transitioning off of animal-based milk, try soy milk,” she says. “The color and consistency are somewhat similar to cow’s milk.”
Read also: Eligibility for Food Assistance
Vitamin D
Vitamin D deficiency is common in the general population.
Essential Fatty Acids
Essential fatty acids are fatty acids that humans must ingest for good health because our bodies do not synthesize them. Only two such essential fatty acids are known: linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid). Three other fatty acids are only conditionally essential: palmitoleic acid (a monounsaturated fatty acid), lauric acid (a saturated fatty acid), and gamma-linolenic acid (an omega-6 fatty acid). The fatty acids that vegans are most likely to be deficient in are the omega-3 fats (n-3 fats). Consumptions of the plant version of omega-3 fats, alpha-linolenic acid, are also low in vegans. Adequate intake of n-3 fats is associated with a reduced incidence of heart disease and stroke. Foods that are good sources of n-3 fats should be emphasized.
Soy and Breast Cancer
Because of concerns over the estrogenic nature of soy products, women with a history of breast cancer should discuss soy foods with their oncologists.
Practical Guidance for Adopting a Plant-Based Diet
A healthy, plant-based diet requires planning, reading labels, and discipline. The recommendations for patients who want to follow a plant-based diet may include eating a variety of fruits and vegetables that may include beans, legumes, seeds, nuts, and whole grains and avoiding or limiting animal products, added fats, oils, and refined, processed carbohydrates.
Tips for Dining Out
You can call ahead to restaurants and ask if they can accommodate a plant-based meal, suggests Lee. You can also ask the chef or cook to make a vegan dish with veggie broth in lieu of oils.
Common Mistakes to Avoid
Over the years, people have been conditioned to eliminate carbohydrates from their diets, Lee explains. But there’s a big difference between those simple carbs (ahem, Cheetos!) and complex carbs, like sweet potatoes. Your body actually needs those complex carbs which fuel our bodies and provide energy. The lesson here? Don’t fear good carbs! Baked potatoes, sweet potatoes, as well as red lentil, black bean or whole grain pastas can all be part of a balanced, plant-based diet when you eat them in moderation, Lee says.
Plant-Based Snack Ideas
Grab some fruit for a sweet, satiating snack, suggests Lee. Or, you can go for some veggies like celery, carrots or broccoli dipped in oil-free hummus. Another idea? Whole grain toast with avocado and tomato, she suggests. During your next movie night, enjoy some popcorn without the butter. Pop the whole grain on the stove or microwave, rather than going for the packaged microwaved popcorn, Lee says. To give your snack some flavor, take a look at your spices, including nutritional yeast, and get creative. Some lime juice, lime zest, chili powder and cumin can give your popcorn a burst of citrus and spicy kick, for example.
Pantry and Refrigerator Staples
When it comes to dried foods, Lee suggests stocking up on lentils and no-sodium or low-sodium beans, as well as brown, black or wild rice, quinoa and whole-grain pastas. Low-sodium veggie broth is a good staple to help make soups and stir-frys, she says. Also, stock up on fruits and vegetables-fresh or frozen.
The Bowl Method
An easy way to start getting your plant-based protein at home is with the bowl method. It’s a quick, customizable approach to meals that Dr. "I typically start off with choosing a whole grain like brown rice, some kind of legume, black beans, tofu, or tempeh," he says, adding that things like rice noodles or potatoes work too. Plus, it’s easy to keep the bowl method healthy. You can buy canned beans and rinse them off for a salt-free base, or frozen vegetables for easy prep. Sometimes Dr. Batiste will even use frozen rice if he doesn’t feel like cooking. "We’ve made food challenging," he says.
Tailoring Plant-Based Diets to Individual Needs
A plant-based diet is not an all-or-nothing program, but a way of life that is tailored to each individual. It may be especially beneficial for those with obesity, Type 2 diabetes, high blood pressure, lipid disorders, or cardiovascular disease. The benefits realized will be relative to the level of adherence and the amount of animal products consumed. Strict forms of plant-based diets with little or no animal products may be needed for individuals with inoperable or severe coronary artery disease. Low-sodium, plant-based diets may be prescribed for individuals with high blood pressure or a family history of coronary artery disease or stroke. A patient with obesity and diabetes will benefit from a plant-based diet that includes a moderate amount of fruits and vegetables and minimal low-fat animal products. Severe obesity may require counseling and initial management with a low-calorie diet or very-low-calorie diet and the supervision of a physician’s team. Patients with kidney disease may need a plant-based diet with special restrictions, for example fruits and vegetables that are high in potassium and phosphorus. Finally, patients with thyroid disease will need to be careful when consuming plants that are mild goitrogens, like soy, raw cruciferous vegetables, sweet potatoes, and corn.
tags: #kaiser #permanente #plant #based #diet #guidelines